ABSTRACT
The purpose of this article is to present data on malaria in the central highland plateaux of Madagascar and strategies to improve the national malaria control program. Use of rapid diagnosis strips, early home-based fever management with pre-packaged chloroquine treatment kits and proposed new therapeutic combination based on artemisinine are discussed for management of patients with high suspicion of malaria attack. Preventive measures including alternated targeted and full-house indoor spraying for vector control, use of insecticide-impregnated bednets, implementation of intermittent preventive treatment in risk groups, optimization of the epidemic early detection and warning system using the Lot Quality Assurance Sampling method for epidemiological investigation if the alert threshold is exceeded, and provision of rapid diagnosis strips are presented.
Subject(s)
Malaria/prevention & control , Humans , Madagascar/epidemiology , Malaria/diagnosis , Malaria/epidemiology , Quality Assurance, Health Care , Sampling StudiesABSTRACT
Le present article presente le paludisme sur les Hautes Terres Centrales de Madagascar et les strategies pour ameliorer les composantes du programme national de lutte contre le paludisme. Pour la prise en charge du patient suspect d'acces palustre; l'utilisation des bandelettes de diagnostic rapide; la prise en charge precoce a domicile par la chloroquine pre-emballee et les reflexions sur les nouvelles combinaisons therapeutiques a base d'artemisinine sont discutees. Pour les mesures de prevention; l'alternance des pulverisations intra domiciliaires ciblees et generalisees dans la lutte antivectorielle; l' utilisation de moustiquaires impregnees d'insecticides; le passage au traitement preventif intermittent pour les groupes a risque; l'amelioration du systeme de surveillance et d'alerte epidemique par l'utilisation de la methode de Lot Quality Assurance Sampling pour l'investigation epidemiologique en cas de depassement du seuil d'alerte et la mise a disposition des bandelettes de diagnostic rapide sont etudies
Subject(s)
Environmental Monitoring , Malaria , Sentinel SurveillanceABSTRACT
To alleviate the insufficient number of experienced medical teams invited to and accepting to monitor the effectiveness of drugs prescribed to patients with a diagnosis of uncomplicated malaria and to insure the surveillance of the susceptibility of P. falciparum to current antimalarials used in Madagascar, there is a need to draw a feasible study protocol carefully discussed with them. We carried out a preliminary study in two rural areas and assessed the efficacy of sulfadoxine-pyrimethamine (SP) for curing uncomplicated P. falciparum malaria, with a simplified protocol based on the principle of observational study. A single dose of SP was given on day 0 with paracetamol. The persons to whom the drugs were administered accepted two other interventions of one member of the medical teams on day 14 and day 28. Nineteen patients, 3-63 years old, fulfilled the follow-up. The efficacy of this combination was noted for the 19 persons. Our results show that P. falciparum strains are susceptible to SP. Since SP will be used in intermittent preventive treatment in pregnant women in Madagascar, one way to delay the occurrence of SP resistant parasites will be (a) to avoid massive use of SP for the non pregnant persons and (b) to monitor susceptibility of P. falciparum to SP as part of pilot studies using standard WHO protocol (which is not really easy for most of the peripheral health facilities--with the follow-up procedures with clinical examination and parasitological control at Days 0, 1, 2, 3, 7, 14, 21 and 28), and routinely with simplified protocol such as the analytical observational study illustrated in this present study. Limit and advantage of observational study are discussed.
Subject(s)
Antimalarials/therapeutic use , Malaria, Falciparum/drug therapy , Pyrimethamine/therapeutic use , Sulfadoxine/therapeutic use , Adolescent , Adult , Child , Child, Preschool , Climate , Drug Administration Schedule , Drug Combinations , Drug Monitoring , Drug Resistance , Feasibility Studies , Female , Follow-Up Studies , Humans , Madagascar/epidemiology , Malaria, Falciparum/epidemiology , Malaria, Falciparum/parasitology , Male , Middle Aged , Observation , Parasitic Sensitivity Tests , Research Design , Residence Characteristics/statistics & numerical data , Rural Health/statistics & numerical data , Treatment OutcomeABSTRACT
If seafood poisonings are well documented in the Pacific region, they are not often reported in the Indian Ocean. In Madagascar, fishermen and people living in coastal areas are traditionally aware of seafood poisonings. Mass intoxications were described in the sixties, including lethal cases following sardine ingestion. From 1989 to 1993, 28 ichtyosarcotoxism cases, mainly ciguatera occurring in children, were reported in Tulear hospital. From July 1993 to May 1996, nine seafood poisoning outbreaks occurred in coastal villages after turtle, shark and sardine meals. Clinical symptoms were related to marine toxins. For turtle intoxications, gastro-intestinal symptoms are the most frequently seen (acute stomatitis, dysphagia, vomiting and diarrhea), with case fatality rates around 7%. For shark intoxications, the most frequent symptoms were neurologic (paresthesia specially peribuccal and extremities), and gastro-intestinal (diarrhea and vomiting), with specific case fatality rates varying from 0% to 30%. For sardine intoxication, symptoms were gastro-intestinal (vomiting) and neurologic (paresthesia), and from the two intoxicated people one died. Two previously unknown biotoxins were isolated from the liver of a shark responsible for a mass poisoning, namely carchatoxins. For the turtles, the search of chelonitoxin is under way. For the sardines, clupeotoxin was isolated. Because of the frequency and the gravity of collective seafood poisonings occurring in recent years, the Ministry of Health has implemented a Seafood Poisoning National Control Programme. This programme is based on three major strategies: the setting of an epidemiological surveillance network, the prevention of the communities through educational programmes, and the development of research on marine eco-environment.
Subject(s)
Disease Outbreaks , Marine Toxins/poisoning , Seafood/poisoning , Animals , Humans , Madagascar/epidemiology , Poisoning/epidemiology , Poisoning/etiology , Poisoning/prevention & control , Population Surveillance , Public Health Administration , Sharks , TurtlesABSTRACT
The authors reported the results of paludometric and entomological studies carried-out for two years: 1995-1996 in two localities: Ampanihy and Ankilimivory located in the South of Madagascar. These studies followed a suspect malaria epidemic in Ankilimivory in June and July 1994; the population plasmodic index was of 45%. In April 1995, this data was of 35% in Ampanihy and of 15% in Ankilimivory. Entomological studies carried out in April 1996 allowed to find Anopheles funestus in Ankilimivory and Anopheles gambiae l. s. in the two localities. Both the endemicity of malaria and the role of A. funestus had to be taken into account in the southern part of Madagascar. Until now, rare epidemics in this area were thought to occur only when climatic conditions were favorable, mainly during the rainy season. However, other factors, linked with the development could also facilitate the upset of epidemics, e.g.: irrigation programmes.
Subject(s)
Anopheles/parasitology , Endemic Diseases/statistics & numerical data , Insect Vectors/parasitology , Malaria/epidemiology , Malaria/transmission , Adolescent , Adult , Age Distribution , Animals , Anopheles/physiology , Child , Child, Preschool , Female , Humans , Incidence , Infant , Insect Vectors/physiology , Madagascar , Malaria/parasitology , Male , Population Density , Population Surveillance , Prevalence , Seasons , Sex DistributionABSTRACT
Authors record the results of entomological and paludometric studies which were run on July 1994 in Ampanihy (Southern Madagascar), since an epidemic of malaria occurred in that region. Although the risk of epidemic malaria is described in the Southern Madagascar, paludometric indexes found in these surveys are pertinent with a mesoendemic malaria. The entomological survey found. A gambiae complex and A. funestus. Complementary surveys are proposed to improve the knowledge of the epidemiology of malaria in this area.
Subject(s)
Disease Outbreaks , Malaria, Falciparum/epidemiology , Malaria, Vivax/epidemiology , Adolescent , Age Distribution , Animals , Anopheles , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Madagascar/epidemiology , Malaria, Falciparum/blood , Malaria, Falciparum/transmission , Malaria, Vivax/blood , Malaria, Vivax/transmission , Male , Population Surveillance , Risk Factors , Severity of Illness IndexABSTRACT
The authors describe the results of an entomological study run in December 1994 in the little town of Bezaha (South-Western Madagascar). The observed entomological indexes are those of an intensive malaria transmission area. The authors suggest to organize a longitudinal entomological survey along with a clinical and parasitological study. They also point out the fact that they found two microfilariae Wuchereria bancrofti in an Anopheles funestus female.
